'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

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New research will help GPs accurately identify which patients with rectal bleeding have high risk of cancer and require urgent referral.

A study of 319 patients aged over 34 presenting in primary care with rectal bleeding found only 3.4 per cent had colorectal cancer. But the prevalence increased to 9.2 per cent when bleeding was associated with a change in bowel habit and to 11.1 per cent when associated with no perianal symptoms.

'More than 96 per cent of the patients who present to their GPs with rectal bleeding do not have cancer,' commented lead author Mr Michael Thompson, consultant colorectal surgeon at the Queen Alexandra Hospital in Portsmouth.

'The combination of rectal bleeding with a change in bowel habit to increased frequency of defecation with or without loose motions, and without perianal symptoms and an age over 60 years, should be used to identify those patients at higher risk of cancer for more prompt referral to hospital,' he added.

Dr William Hamilton, clinical research fellow with an interest in primary care cancer diagnosis at the department of primary health care, University of Bristol, said: 'It's a helpful prospective study, and I would expect GPs to refer more rectal bleeding as a result of it ­ whatever the NICE guidelines say!'

He added: 'Significant polyps were found in 7.8 per cent. So the total yield of "nasty things in your colon" was over 10 per cent. Surely that justifies investigation, and rapidly?'

On the basis of the results, published in the December issue of the British Journal of General Practice, Mr Thompson also recommended that patients at lower risk and with a low level of anxiety could be treated for longer in primary care.